KADAR SERUM AMYLOID A PADA SEPSIS DENGAN OUTCOME KEMATIAN DAN TANPA KEMATIAN

RAMA ALGI OCTAVIANTO, dr. Rizka Humardewayanti Asdie SpPD-KPTI; Prof. Dr. dr. Nyoman Kertia, SpPD-KR

2015 | Tesis-Spesialis | SP Ilmu Penyakit Dalam

Latar Belakang : Sepsis merupakan suatu proses inflamasi sistemik atau Systemic Inflammatory Respons Syndromes (SIRS) akibat respon klinis terhadap adanya infeksi. Akibat dari infeksi ini, terjadi perubahan respon fase akut (Acute-phase response) seperti Serum Amyloid A (SAA). Kadar SAA memiliki potensial sebagai marker sepsis dan diproduksi oleh hepar saat respon fase akut dan telah menjadi faktor prognosis sepsis. Tujuan penelitian adalah untuk mengetahui kadar SAA pada sepsis dengan outcome kematian di RSUP dr. Sardjito Yogyakarta lebih tinggi dibanding tanpa outcome kematian. Metode : Enam puluh delapan pasien sepsis yang dirawat di Bagian Ilmu Penyakit Dalam RSUP dr. Sardjito Yogyakarta antara Juni 2014 s.d. Desember 2014 diperiksa kadar SAA serumnya kemudian dihubungkan dengan outcome kematian setelah pulang dari rumah sakit. Hubungan antara kadar SAA dengan outcome kematian di analisis dengan uji Mann-Whitney. Hasil : Pasien dengan outcome kematian sebanyak 32 orang, dengan kadar rerata SAA lebih tinggi (43,6 mg/l) dibanding tanpa outcome kematian (26,3 mg/l). Analisis chi-square didapatkan p sebesar 0,002 dengan risiko relatif (RR) dengan IK95% (1.33 to 3.7) 3,7) didapatkan sebesar 2,21. Cut-off poin SAA > 51,1 mg/l dapat membedakan antara outcome kematian dan tanpa kematian dengan sensitivitas 78% serta spesifisitas 61%. Kesimpulan : Kadar SAA lebih tinggi pada pasien sepsis dengan outcome kematian

Sepsis is a systemic inflammation response or systemic inflammatory response syndromes (SIRS) of clinical response to infections. Due to these infections, acute phase responses occurred. These responses involve changes in concentrations of several protein plasma such as A amyloid serum (AAS). Amyloid A serum is an apolipoprotein which has potency to become septic marker and produced by liver during acute phase response, have begun to be established as septic prognosis factor. The objective of this study is to determine the difference of AAS level in sepsis with death outcome is higher in Sardjito Central Hospital Yogyakarta. Methods: Sixty-eight patients with sepsis were treated in the Section of Medicine Hospital dr. Sardjito between June 2014 until December 2014, then examined serum levels of SAA is associated with outcome of death after discharge from the hospital. The relationship between the levels of SAA with mortality outcomes were analyzed by Mann Whitney test. Results: Patients with outcome of death by 32 people, with a mean of SAA higher levels (43.6 mg / l) compared with no outcome of death (26.3 mg / l). Chi-square analysis was obtained p of 0.002 with a relative risk (RR) with IK95% (1.33 to 3.7) obtained by 2,6. Cut-off points SAA > 51.1 mg / l can distinguish between the outcomes of death and no deaths with sensitivity 78% and specificity of 61%. Conclusion: SAA levels were higher in septic patients with outcome of death

Kata Kunci : serum amiloid a, sepsis, kematian, respon fase akut